Preparing to Die

She was like so many other patients I had seen: thin, pale, elderly, and short of breath.  The oxygen mask and its large ballooning bag seemed unnatural and almost comically oversized on her face, obscuring everything but her eyes and the dusky, blood-matted hair plastered to her forehead.  She squeezed the bag, hungrily trying to force more air into her cancer-infested lungs.  The situation was bad.  I knew it, my team knew it, and it was becoming increasingly clear that she knew it as well.

Some of the other medical staff said that she showed signs of confusion, but her words were clear in speech and meaning.

"Oh God... This is it... I don't want to..."

She was afraid of so many things, and we weren't doing much to help that.  There was the strangeness of the environment, the necessary but painful things we were doing, and above all, the dreaded possibility that she could die, heightened by the worry and concern frozen on my face.  One of the attendings was repeatedly jabbing a large needle (I mean inches long) into her neck and she would occasionally moan and move feebly in pain.  I was holding her hand and doing my best to reassure her, but I didn't know what to say or to think.  In that moment, all the isolation and chaos and alienation that has become modern medicine hit me hard, and I looked around the room littered with medical waste and harsh noises and complete strangers.  I thought, "No one should have to die this way," and realized that it was not the first time I have thought this.

These words seem so melodramatic and cliched now that I write them, but perhaps I have the manner of things backwards.  Perhaps melodrama is so overdone because it tries to imitate these sorts of events and emotions with some reflection of their gravity and substance.  But there is no truth to the imitation, because in reality no words can express the absolute lack of poetry or grace that characterizes death.  There is no premonitory music that plays in the background, no dramatic panning of camera angles or dynamic lighting to throw the monumental event into starker contrast.  The physics and mechanics of death are unglamorous.  We often die in appalling ways: lying in a pool of our own urine and bodily waste, surrounded by alien and otherwise threatening entities, unknown and possibly unloved.  Death can easily happen in the next room without leaving anyone the wiser; in fact, that is often why people do die... because no one else knew it was likely to happen.  In so many ways, death is one of the most unmagical and ordinary things that happen.  As medical students are often taught, "Nothing else in existence is more certain or inevitable."

And yet there is such a strong, innate resistance to this notion, one that has been ritualized in every known human culture.  We make death meaningful, as if the act of remembrance and reverence elevates the importance of who and what has passed.  Such respect is somehow written into our emotional DNA, though some philosophers (and one of my professors) have argued that this is because human beings are arrogant, elevating their self-worth something of greater value than what our naturalistic compositions warrant.

But this is not what I thought of, staring at the large needle boring itself into and out of her neck.  I did not philosophize or ruminate.  Instead, I looked down at my own hand, which was holding hers, and realized that I was the one clenching my fists the most.  I was not any more prepared for her death than she was, and for some bewildering reason, this gave me great comfort at the same time that it struck me with sorrow.

I am not sure why I am still writing, except that I desperately want to believe in the Divine.  I want to believe in persistent purpose, in the significance of death, in a life beyond what we can see and know in the here and now.  All the evidence and momentum of this great engine of the soul inside me screams for something more and meaningful and lovely and beautiful and it will not be denied, it cannot be refused, it must not be quieted.

You are witness to it.  Speak its truth to me, again and again.  I want for us to be eternal, for us to be prepared and consequently, divine.

Listen, I tell you a mystery: We will not all sleep, but we will all be changed— in a flash, in the twinkling of an eye, at the last trumpet. For the trumpet will sound, the dead will be raised imperishable, and we will be changed.  For the perishable must clothe itself with the imperishable, and the mortal with immortality.  When the perishable has been clothed with the imperishable, and the mortal with immortality, then the saying that is written will come true: “Death has been swallowed up in victory.”

  “Where, O death, is your victory? 
   Where, O death, is your sting?”

1 Corinthians 15:51-55

Dedicated to my patient.  Reprinted from http://wasaiwarrior.xanga.com/738626008/preparing-to-die.

Stall

I could name a million reasons describing why progress on this book has been stalled, but the main one is this: I tried too hard.  I tried to figure out a plot.  I tried to expound on points I thought were important but weren't as inspiring.  I tried to write a book and not a memoir.

Zinsser puts it best:

...beware of "about." Beware of deciding in advance how your memoir or your family history will be organized and what it will say. Don't visualize the finished product at the end of your journey; it will look different when you get there. Be ready to be surprised by the crazy, wonderful events that will come dancing out of your past when you stir the pot of memory. Embrace those long-lost visitors. If they shove aside some events you originally thought you wanted to write about, it's because they have more vitality. Go with what interests and amuses you. Trust the process, and the product will take care of itself. - Writing About Your Life

 Things have changed.  You'll see.

I had forgotten what sorrow, that fog of the soul, feels like. It doesn't feel good.

Repository

As a participant of this year's NaNoWriMo competition, I need a dumping ground for the literary detritus that will eventually constitute a whole book but isn't as public as my Xanga site. Hence, new life to this blog.

Bang for your buck? You only got one shot.

Obstetrics is interesting because it deals with very practical, very everyday sorts of things where people don't have to be sick in order to see you. Pregnant women and newborn babies, contraceptives and vitamins, PMS and psychotic women. In fact, I was reading a list describing PMS symptoms and found myself nodding my head with almost every point. The more I understand myself, the more it feels like I emote like a female, heavy flow or not.

Obstetricians are funny people too. A lot of them curse like surgeons (I mean sailors) and they're very expressive and dramatic. My senior attending had us in the back kitchen one day and was just "shooting the shit" with us students. She's a peppy, robust, energetic grandmother with a salty tongue that talks faster than I can breathe. We were chatting about different specialties in medicine and she told us about why she liked obstetrics and gynecology:

"Say you get this interesting case in internal medicine - a 78 year old lady or something - and you work your ass off to figure out what's wrong with her. You fix it and end up adding another two years to her life. She gets to see her grandson born, spend some time with her family, etc, etc, whatever before she dies. That's great; you just gave her two years that she wouldn't have had and that's a wonderful thing. But when I get a woman in labor with a bad complication - a cord prolapse or something - and I snatch that baby out and save it... I just saved 80 years of potential right there. I deliver another baby that day: 70 years. Hell, I'll even take 60 years. Who knows what that kid will be some day? Maybe I just delivered a Nobel Prize winner. If you're talking about bang for your buck, nothing can beat OB."

And then we had a baby born dead.
And another with shoulder dystocia and a withered arm.
And another with unexpected Down Syndrome.

The attending and I were talking about the baby with the withered arm, the one who barely escaped birth with his life, and she said to me, "You know, if I had just known... if I had just seen what was coming, I would have done anything to save that kid's arm. These guys, the residents, they sometimes forget what we're dealing with. That kid is gonna live with that withered arm for the rest of his life, and I wonder how I'll sleep at night thinking about what I could have done to stop it from happening..." She was silent for a while. I felt uncomfortable.

I have this urge to write something comforting, a little happy ending to these stories so we can all walk away from this entry with warm & fuzzy thoughts in our heads about chubby and smiling babies. But just like that
snap back to reality,
oops! there goes gravity

do not miss your chance to blow, cause
this opportunity comes once in a lifetime.

Finally freed of my academic obligations, I was at complete liberty to brood without guilt. There was room at last for my mind to breathe yet I only found myself perturbed and afraid of the conclusions it might reach if it did.

I still don't know if it was coincidence that my new iPod was out of batteries, that those old sermon tapes were still sitting on the dashboard of my car, that the 4 hour drive down to Virginia had me bored of John Mayer before I could even leave the state. All I know is that something compelled me to dust off a cassette my parents had left in the car years ago and listen in surreal surprise as the piercing voice of my old pastor came through the speakers to say:

Today, if you hear his voice,
do not harden your hearts
as you did in the rebellion,
during the time of testing in the desert,
where your fathers tested and tried me
and for forty years saw what I did.

See to it, brothers, that none of you has a sinful, unbelieving heart that turns away from the living God. But encourage one another daily, as long as it is called Today, so that none of you may be hardened by sin's deceitfulness. We have come to share in Christ if we hold firmly till the end the confidence we had at first...

I was immediately transported to the moment I first heard that message. I remember sitting on the right side of the sanctuary, close to the front, where I could nearly see the tears as they ran down his face. I was gripped by the same tightness in my gut as he described how one of his youth group kids was killed in a tragic car accident the night before. I remembered it all so clearly, and it reminded me that all the events that shook my faith so severely began with the announcement that this pastor, this man I had come to love and trust so much, was leaving our church. I remembered how much I missed his voice and the messages it carried.

The stereo crackled as the car trundled over the massive bridge spanning the Delaware Water Gap. I could see the sun setting just ahead of me, obscured just enough by distant cloudy wisps to bathe the horizon in gold and orange hues. It was serene and tense, a Sunday afternoon-like moment that captured the pang and pleasure of time split in between other moments of significance. The scene captured the ambiguous sentiments I had towards myself: a body in motion, transient and uncertain, hovering yet moving towards a destination of intangible and overwhelming meaning. Unspeaking and immaterial, indifferent and all-encompassing, eternal and momentary, stood this magnificent sunset to remind me of... what?

Today, if you hear his voice, do not harden your hearts...

I listened to him speak. I knew what he would say, knew what my response would be even before it happened. I could feel the hardness of my own heart, its cold resistance constantly accusing and justifying and lashing out in anger and hurt at this god, this so-called god, this cruel and petty god, this weak and foolish god...

...if we hold till the end the confidence we had at first.

And I knew that I wanted him back. More than anything in my life, I wanted God back. I wanted to be free from the self-pity, the nagging insecurities, the constant doubts and questions and philosophical excuses to refuse belief. I wanted to be naive, to trust and have faith, to believe in something anything one thing I could say I knew was true.

He talked about how Jesus stopped and drew near to poor and blind Bartimaeus to ask him, "What do you want me to do for you?", how God was stopping even now to ask the same question to us. And my heart leapt and yearned within me and screamed, "I want you! I want to be happy again! I want to know you want me too! I want to believe! I want I want I want I want..." and all the suppressed anguish and sorrow and longing over the past year spilled out and the tears blurred the sky until it streaked blood-red in my eyes and died in the west and I cried and sobbed and heaved and retched until I realized the last time I did this was when I truly realized that Sonia was dead and would never come back and that it was all so messed up and awful and god why god why god why god why?

Learning to Pray

I don't know how to pray, but I do it anyway.

I must admit that most of my prayers feel like a gamble at Russian roulette: something as important as a life can be at stake and yet, despite earnest and hopeful intentions, I still find myself dreading the outcome. To pray requires the kind of desperation only found in games of chance. It is an act of last resorts, admitting that my own means and ways of seeking resolution have failed and that the sparing or taking of life is now at the mercy of something I can't see that happens to have a record of unpredictably dispensing both pleasure and pain.

It constantly makes me wonder if the Christian platitudes that God "makes all things work for the good of those he loves" are really simply wishful thinking that struggles to give the random outcomes of life - illnesses, failed ambitions, unexpected rewards - some sort of meaning and sense. Could we simply be at the mercy of quantum dice, and is the image of an omnipotent and omniscient God any more beneficial than the narrative we weave for ourselves? Perhaps God is even malevolent or capricious like the Greek deities, teasing us with guilt and pleasure for the sheer sake of taking entertainment in our obsequious praises and the incredible lengths gone through to win favor.

I think it really comes down to the question of whether or not you trust God. Do you trust that he is good? It does not take much to interpret the events of your life in a way that paints a benevolent portrait of God, much in the way Pip fantasized about his benefactor in Great Expectations. Do you trust him to be hostile? Again, it does not take a large stretch in the imagination to see God as one who consistently tortures his creation. Do you trust him to be completely unreliable? This is perhaps the easiest delusion of them all.

To me, God simply defends himself by giving me a situation that definitively demonstrates my own pathetic inability to control my small life, piercing me with the image of the suffering Emmanuel, and leaving me with the pregnant silence of a personal decision. It is as if he says, "If you will take me, you must take me as I AM. You must trust me as I AM and learn to know and respect and love me as I AM. I have done no less for you."

And so I pray out of desperation and longing and fear because God is, by nature, someone who is invisible, largely unknowable, and immensely dangerous. But I must learn to pray out of trust and love and compassion because that is - generally and vaguely speaking - exactly who he says he is. I suppose there is little choice but to take him at his word.

Our father, who art in heaven,
Hallowed be your name
Your kingdom come, your will be done
On earth as it is in heaven.
Give me this day my daily bread
And forgive my transgressions,
As I have forgiven my transgressors
And lead me not into temptation
But deliver me from evil.
For yours is the kingdom and the glory
And the power forever,
Amen.